Benefits and barriers of National Health Authority's 'ABHA'

Physicians in the US spend considerable time on computer screens updating healthcare records, but we cannot afford to lose this time in a country like India

Last week, the National Health Authority (NHA) announced integrating the Ayushman Bharat Digital Mission (ABDM) with the Aarogya Setu app. The step was claimed to be a landmark on the journey of digitising the health sector in India. It will help Indians generate a unique health identity, ABHA (Ayushman Bharat Health Account), from their Aarogya Setu account. The merger will allow citizens access their personal health records and useful services from the national digital health system, it was claimed. While this integration offers various opportunities and benefits for both the service providers and the beneficiaries, it is necessary to look at its challenges.

What is ABHA, and where does it currently stand?

ABHA is a person's unique digital health ID. Once a 14-digit ABHA ID is generated, a person can add, maintain and access their health records. One can link and share these records, such as prescriptions, lab reports and hospital records, with registered health professionals and health service providers. ABHA IDs can be generated using either Aadhaar or driving license details. As of January 12, 2022, 16.4 crore ABHA IDs had been generated under the ABDM. With more than 21 crore registered users on the Aarogya Setu app, the integration aims at exponentially increasing the number of ABHA IDs.

What does ABHA offer?

The objective of this initiative is clear. It is to tilt the focus of the healthcare sector towards digitisation. The plan is to make healthcare services more accessible and equitable. The integration with the Aarogya Setu App is intended to bring about positive changes in health outcomes. Apart from this, the official release from the NHA says that ABHA is also aimed at increasing citizen participation.

The first and foremost benefit of this is that individuals will be able to maintain and secure their health records digitally. Moreover, the platform will give ready access to health data to doctors, services, and healthcare providers to people from anywhere in the country. Many times, people from rural regions do not get access to health services due to physical and economic challenges. ABHA can potentially help in bridging that gap. The change will drive convenience for all, probably leading to better health outcomes. Next comes the benefit of consent.

The sharing of digital health records is only permitted with the individual's consent, which might be permanent, temporary, or time-bound. This data can be anonymised and used for research and epidemiological analysis. When enough people digitise their healthcare records, data generated can serve as real-time feedback for our various healthcare schemes and interventions. ABHA is not only meant for patients but adds an excellent opportunity for doctors, health-tech organisations and policymakers.

Potential pitfalls of ABHA

There are several concerns regarding health IDs, especially with data stored at a central location. Currently, almost all patients' reports, tests, and prescriptions are paper-based in our country. Developed countries have been moving towards the digitisation of healthcare records with a lot of undesirable effects. Reports suggest that physicians in the USA spend more than half of their time on computer screens updating healthcare records. We cannot afford to lose this time in a resource-scarce country like ours. Unless we find a solution for this, having digital healthcare records will be a distant pipe dream.

Healthcare records are quite personal and are likely to be misused. Data in the central depository can be stolen and sold to anyone, from a spammer to an imposter. Keeping data at a central location instead of being stored with the individual makes it easier to steal it. Although ABHA is presently voluntary, there are high chances it will be made mandatory for accessing some services, similar to the trajectory of Aadhaar. This will lead to a considerable part of the population being excluded.

India has low mobile penetration, with smartphone usage even lower. The benefits of digitalisation will not be realised amongst the rural and the poor. In 2005, the UK's National Health Service (NHS) had started a similar programme which was not successful and was eventually shut down. The possibility of something similar happening with ABHA is even higher.

Conclusion

Needless to say, India's digital healthcare space has a lot of room for growth and improvement. ABHA is a push in the right direction. Although complete health digitisation in India will probably take decades, it will be interesting to see how ABHA can hasten the revolution.

(Mahek Nankani is Assistant Programme Manager at The Takshashila Institution. Harshit Kukreja, MBBS, is Research Analyst with The Takshashila Institution)

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.

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